Geri Weeks 1, 2,3

Gender
Health
History

Involves ones whole being
Vital components are physical, emotional,mental and spiritual

A state of being and feeling that one strives to achieve through the effective health practices

Life expectancy is increasing even in the poorest countries.
An explosion of older adults primarily persons of color(hispanic/Latino)

Western Europe and Japan

Asia, Latin America, Africa

Japan & Sweden

Social, Biological, Psychological, Spiritual, Cultural, & Environment

Serves as a guide for prioritizing nursing interventions to promote healthy aging. The needs of basic levels must be met before higher levels can be achieved. As basic level needs are met the satisfaction of higher level needs become possible.

Air, Fluids, Comfort, Activity, Nutrition, Elimination, Skin Integrity.

Safety & Security
Belonging & Attachment
Self Esteem & Self Efficacy
Self Actualization & Transcendence

Caution
Planning
Protections
Sensory Acuity

Love
Empathy
Affiliation

Image
Identity
Control
Capability

Seeking
Expanding
Spirituality
Fulfillment

Provide care according to the various models
Draws on the expertise of the specialist in planning and evaluating care.

Acute
Community & Home based
Long term

May function in the direct care provider role ans well in leadership & management positions

Provide comprehensive assesments and may provide & supervise care for older people with a variety of needs

Independent decision making, Nurse Leadership, and evaluation of nursing models of care on patient outcomes

The need to communicate, be listened to, be heard, does not change with age or impairment

Referent
Sender
Message
Channel
Reciever
Environment
Feedback

Intrapersonal
Interpersonal
Public

An outgrowthof ageism in which younger people alter their speech based on the assumption that all older people have difficulty understanding and comprehending

Attentive listening, Authentic presense, Non-Jugmental Attitude, Cultural Competence, Clarifying, Giving Infromation, Seeking Validation of Understanding, Keeping focus, Using open-ended questions

Can interfere with communication with others and interactional output. Can diminish quality of life. Associated with multiple negative outcomes eg. depression, falls, cognitive decline

Damage to any part of the inner ear or neural pathways to the brain
Precubycusis= most common form related to aging in the US

Involves abnormalities of the external and middle ear that reduce the ability of sound to be transmitted to or through the middle ear

Cataracts, Macular degeneration, Glaucoma, Diabetic retinopathy.

Snellen reading of worse than 20/40 but better than 20/200

worse than 20/200

Strokes, head injuries & accidents

Speaking, Understanding, Reading, Writting, and gesturing are effected

Wernickes. People speak easily but they don't make any sense. They also have difficulty understanding spoken language

Broccas. They understand but speak slowly w/ miminal words. Loss ability to voluntarily control the movements of speech. Different with oral and written.

Language disorder where the muscles of speech are disrupted in the brains transmission of signals so a person struggles to speak

Language disorder causes word finding difficulty

Labguage disorder where person cannot understand words and cant speak intelligibly

A speech disorder caused by weakness or incoordination of the speech

Face individual,
Use moderate speed of speech,
lowertone of voice.
Use non verbal approaches (visual aids) reduce background noise

Get patients attention before begin talking
Get down to persons level
When others in room / lightly touch thier arm to acknowldege when you are speaking to them
Offer arm when walking if person is blind

Avoid patronizing and chilish phrasing
Allow plenty of time & speak slowly
Repeat & Rephrase
Use Non verbal approaches eg picture board

Does not affect the persons intelligence
Repeat back what person said
Repeat only part of message you did not understand so person doesn't have to repeat entire message

On eof the most important psychological tasks for the elderly
Recal of past
Occurs form chilhood onward at lifes junctions
Culivates sense of security,
sense of belonging & self esteem
Confirms uniqueness

More formal than reminisenceTakes person through there life in chronological order Process occurs when person realizes death is near
Creates resurgence of unresolved conflicts

Highest level of independence, fuction & comfort
"Age in Place"

Relieves economic burdens
Many benefits
Can be stressful w/o adequete prepration

When elderly widows or widowers live together in a house

Community based group programs, designed to provide some social & health services to persons who need supervised care in a safe setting during the day

All inclusive care for the eldely
Alternative to nursing home care for the frail who want to live independently in the community with a high quality of life

Designed to make independent living feasible with the least effort on the part of the elder
Numerous combinations; single family homes, apartments, activities, optional services, meals int he home, cafeterias ect

Non-medical, Community Based,
House two or more adults,
Provides services eg. meals, medication reminders, activities, transport, assistance with ADL's
For elders who need more care than shared housing but nursing home is not needed

Long term choice for persons who need more than an independent living environment
Do not need 24 hr a day skilled nursing care & the constant monitering of a skilled nursing facility

Round the clock care
Paid by government
Highly regulated
Most expensive

Faculty requires licensed professionals with focus on the management of complex medical needs

Facility requires 24 hr personal assistance that is supervised and augumented by profesional licensed nurses

Skin/Hair/ Nails/
Musculoskeletal
Cardiovascular
Blood vessels
Respiratory
Renal
Endocrine
reproductive
Gastrointestinal
Assesory Organs
neurological
Sensory
Ear and hearing
Immune System

Dermis - loses 20% of thickness/ dermal bld vessels reduced/ Collagen decreasesHypodermis eg some atrophy fat decreases

Less hair as we get older
More for men in ears/nose/eyebrows
More for women in chin and facial areas

Harder thicker brittle dull & opaque
Shape flat & concave instead of convex

Verebral disks - thin causes shrotening of trunk
Stooped & slightly bent posture
Alteration in body shape - lean bidy mass declines & body water is lost
Loose muscle mass and gain adipose around middle at age 40
Reduced bone mineral density
Everything is dryer

Decreased Max coronary bld flow, stroke volume,& cardiac output
Longer time for heart to accelerate & return to resting state
Heart disease #1 cause of accidental death worldwide

Decrease Elasticity & recoil is most sig. change
Blood supply to various organs decreases and peripheral resistance increases
Decreased perfusion of the liver and kidneys

Loss of elastic recoil
Stiffening of chest wall
Inefficient gas exchange
Increased resistance to airflow
Residual volume (what we breath out) increases/lung capacity decreased

fxn decrease
Blood flow through the kidneys decreases 10% per decade
Loss of as many as 50% of the nephrons by age 80%
Decrease in size and fxn in the kidney cortex

Tissues of the body often develop decreased sensitivity to insulin

Some atrophy, fibrosis, and inflammation occur
Diminished TSH and T4 and T3

Menopause, breasts are smaller and always less firm
Ovaries, cervix and uterus slowly atrophy
Vaginal drying and decreased libido
Labia become less prominent and pubic hair thins

Decreased fertility
Erectile changes
Prostatic enlargement

Teeth loose enamel and dentin, become more vulnerable to caries
Roots more brittle and break more easily
Gums more periodontal disease
Taste buds decline in #
Salivary secretion lessens

Contractions increase in frequency but are more disordered and propulsion is less effective
GERD and hiatal hernias more prominent
Decrease in fxn of sphincter

Decreased gastric motility & volume
Reductions in bicarbonate & gastric mucous
Decreased production of intrinsic factor
More susceptible to peptic ulcer disease
Anorexia & Weight loss

Villi become broader,shorter & less functional
Nutrient absorption effected
Peristalsis slowed

Liver decreases in volume & weight
Impaired drug metabolism by liver
Incidence of gallstones increases

Dendrites appears to be wearing out
Number of neurons decrease
Decrease in brain weight and size

Tactile sensitivity in connection with loss of a large number of nerve endings in the skin
Increased sleep disturbances (less REM3 and no REM4)

Extraocular (eyelids loose elasticity and droop)
Lower lashes may curl inward and irritate the eye

Ocular cornea becomes flatter and less smooth, thicker and duller in appearance which results in farsightedness
Arcus – senilis – silver ring around eye (is ok)
Light adjustment, slow d/t decreased responsiveness of pupils and changes in lens
Light scattering/ color deception decreases

Intraocular – retina has less distinct margins
Color clarity decrease/Loss of blues violets and greens
Decreased number of rods = peripheral vision not clear or absent

Auricle, or pinna, losses flexibility/ becomes larger &wider
Auditory canal narrows, causing inward collapsing
Stiffer & coarser hair, lines the ear canal
Cerumen glands atrophy
Ossicle joints between the malleus & stapes develop calcification
Decrease in vestibular sensitivity
Conductive & sensory neural hearing loss (high frequency loss)

Skin thinner & less resistant to bacterial invasion
Reduced number of cilia in lungs leads to increased risk for pneumonia
Friability of urethra increase risk of urinary tract infection
Reduced immunity at cellular level

Loss of elasticity & recoil in arteries & veins are age related
Atherosclerosis & Arterial sclerosis are pathological diseases caused by genetics & environment.
COPD not age related but decreased elasticity of alveoli & increased residual volume is.

Eyes – protect from ultra violet light, avoid eye strain: use bright light when needed. See health care provider promptly for changes in vision. Have a yearly dilated eye exam

Ears – avoid exposure to excessively loud noises, avoid injury with cotton tipped applicators, use assistive devices as appropriate e.g. hearing aids, See health care provider for sudden changes in hearing

Wear and tear theory- cells wear out over time because of continued use and trauma
Cross linkage theory – Accumulation of errors by cross linking, or the stiffening of proteins in the cell (i.e. skin wrinkling, dry)
Free radical theory (mostly accepted) when free radical in cells cause random damage, like environmental pollutants cause increase free radical and increase in rate of damage (smog, ozone, pesticides, radiation)

Based on the integration of the neuro, endocrine, & immune systems.
Emphasis on the programmed deaths of the immune cells from damage caused by the increase of free radicals as aging progresses.
Causes less ability to fight off infections, cancers, pneumonia

Attempted to predict and explain how individuals adjusted to age related changes by looking at ones level of activity and productivity.

In the normal progression, personality traits remain quite stable as men and women age.
Personality influences role activity and ones level of interest in particular roles
Personality influences life satisfaction regardless of role activity.

Erikson – predetermined order of development & specific tasks associated with specific periods in one’s life course.
Ego – integrity vs despair (was modified in old age to be a balance) “ego integrity is tinged with some regrets, Wisdom is balanced with frivolity, and letting go is balanced with hanging on”

Developmental tasks at middle age and later maturity

expanded on Erikson with identification of discrete tasks of late life that, when taken together, achievement of, would result in ego integrity
Ego differentiation vs. work role preoccupation (individual no longer defined by his work)
Body transcendence vs. body preoccupation (self is cared for but does not consume the interest and attention of the individual).
Ego transcendence versus ego preoccupation (self becomes less central and one feels a part of the mass of humanity sharing their struggles and their destiny).

A high degree of life satisfaction
Midlife patterns & ideas are no longer prime motivators
Complex & active coping patterns
A greater need for solitary philosophizing, meditation & solitude (peace & quiet)
Social activities are not essential to well being
Satisfaction with self-selected social activities
Less concern with body image & material possessions
Decreased fear of death
Affinity with past & present generations
Decreased self centeredness & increased altruism

Ranks needs from most basic to self actualization, can’t get to the top (self actualization) without first getting basic needs met (security)

The spiritual aspect of people’s lives transcended the physical & psychosocial to reach the deepest individual capacity for love, hope,& meaning. Nurses must be knowledgeable & respect the rights & rituals of varying religions, cultural beliefs, & values.
Must be considered a significant factor in understanding healthy ageing / there is always something to hope for.
Spiritual connections to the world around them.

The process of acquiring, storing, sharing and using information

Attention span, concentration, intelligence, judgment, learning ability, memory, orientation, perception, problem solving, psychomotor ability, reaction time, & social intactness.

skills that are biologically determined, independent of experience or learning (natural or native)

comprised of knowledge and abilities that the person acquires through education and life.

the ability to retain or store information and retrieve it when needed.
Recall of newly encountered information decreases with age and memory declines are noted w/ complex tasks and strategies.

Age associated memory impairment
Does not meet dementia diagnosis criteria

Basic intelligence remains unchanged with increasing years

Hearing and vision losses
Cognitive impairment
Cultural and cohort variations
Education
Low literacy

Older adults have the ability to: listen
follow directions
complete forms
perform basic math calc's
interact w health professionals & health care setting